Healthcare Provider Details

I. General information

NPI: 1548492648
Provider Name (Legal Business Name): VIKAS GUPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2009
Last Update Date: 08/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 HAMILTON ST
SOMERSET NJ
08873-3102
US

IV. Provider business mailing address

773 HAMILTON ST
SOMERSET NJ
08873-3102
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-2299
  • Fax: 732-545-3596
Mailing address:
  • Phone: 732-545-2299
  • Fax: 732-545-3596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03158900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5703099
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: